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Biomedical subjects

J M Craney

Publications and source records attributed to J M Craney.

7 recordsLinked to original sources
PubMed1997

Implantable cardioverter defibrillators: physical and psychosocial outcomes.

BACKGROUND: The long-term outcomes of living with an implantable cardioverter defibrillator are an important consideration in recovery. However, little is known about physical and psychosocial outcomes beyond 1 year after implantation. OBJECTIVE: To describe the long-term physical and psychosocial adaptation of persons who have had an implantable cardioverter defibrillator for approximately 2 years or more. METHODS: This nonexperimental cross-sectional study used telephone interviews to ascertain the responses of 80 recipients of implantable cardioverter defibrillators to physical and psychosocial questionnaires to explore the long-term outcomes of living with the devices. Subjects eligible for inclusion were selected from the files of an arrhythmia clinic. RESULTS: Hierarchical regression analysis showed that subjects who are not emotional are likely to be more physically active, especially if they are young and male, and that subjects who tend to be emotional are likely to be psychologically distressed and have poorer social and domestic adaptation. Furthermore, use of emotions was a positive predictor of psychological distress and poor social and domestic adaptation. Subjects reported the use of both emotion- and problem-focused coping. Subjects' scores on physical and psychosocial functioning were comparable to scores reported in the literature for patients who have had myocardial infarction or dysrhythmia. CONCLUSIONS: Emotional responses to distress were predictive of little physical activity and psychological distress. Furthermore, young recipients of implantable cardioverter defibrillators and men were predicted to be physically active. Persons who have had an implantable cardioverter defibrillator for approximately 2 years or more can anticipate that their physical and psychosocial functioning will be similar to that of patients who have myocardial infarction or dysrhythmia.

Adaptation, Psychological↗
PubMed1997

Conscious sedation and implantable devices. Safe and effective sedation during pacemaker and implantable cardioverter defibrillator placement.

There is a paucity of research on the use of CS during ICD or pacemaker implantation. Pacemaker patients generally require small amounts of i.v. sedation, in conjunction with local anesthetic agents, to relieve incisional discomfort. Because of innovations in ICD technology, little difference now exists between ICD and pacemaker placement. Studies have reported on the use of deep sedation during ICD implantations, but only one study addressed CS in ICD placement. Whether deep levels of sedation are necessary for DFT testing is not apparent from these studies. Two studies report giving sedation at a level consistent with deep sedation, yet partial loss of protective reflexes was not reported in one of the studies. Further research is needed to explore the use of sedation in ICD implantation. It may be that deep sedation for patient comfort is necessary only during DFT testing or for tunneling of leads to an abdominal generator site, and that CS is more than appropriate for the implant portion of the procedure. Research may disclose that agents such as midazolam and, to some extent propofol, provide an amnesic effect that may mitigate the need for deep sedation during DFT testing or lead tunneling. Another benefit of agents and analgesics such as Fentanyl, is the relatively short duration of sedation, which minimizes recovery time. Patients recover quicker than with general anesthesia and can be discharged the same day in some procedures (e.g., generator replacement). Cost-benefit studies also are needed to compare the cost of anesthesiologist-delivered sedation with that of nurse-administered sedation. A comparison study could explore complication rates, patient comfort, and costs for the two sedation delivery methods.

Aged↗
PubMed1995

Factors related to driving in persons with an implantable cardioverter defibrillator.

A study of 97 persons (mean age = 66 yrs, 79% male) with an ICD for an average of 2.2 years was conducted to determine whether patients resume driving (N = 72) post-ICD insertion despite instructions not to do so. Those who had resumed were queried about their driving habits, the presence of symptoms associated with arrhythmias, the occurrence of shocks in the previous year, and the importance of driving to maintenance of lifestyle. Our assumption was that patients return to driving to maintain their pre-ICD lifestyle of functional independence, and to resume social roles such as provider for the family. Seventy-four percent of subjects reported driving an average of 60 mi/week despite being instructed not to drive by their physician or other health care provider. Of those who resumed driving, > 4% had received a shock while driving. Over 86% of subjects believe driving was an important part of maintaining one's lifestyle. Reasons for driving included necessity (62%), such as to work or a physician appointment, or social (58%), such as driving to the store or church. Symptoms such as dizziness, palpitations and lightheadedness were experienced by 80% of subjects, with 43% receiving a shock from their ICD within the previous year. There were significant correlations between driving and the importance of driving to maintaining one's lifestyle (p < .05), driving for necessity (p < .01), for social reasons (p < .01) and being the primary driver in the family (p < .05).

Activities of Daily Living↗
PubMed1993

Radiofrequency catheter ablation of supraventricular tachycardias: clinical consideration and nursing care.

Radiofrequency catheter ablation is rapidly gaining acceptance as the treatment of choice for many types of symptomatic supraventricular tachycardia (SVT). Introduced in humans in 1987, the procedure has been met with enthusiasm because of its relative safety and high success rate in curing SVT. The typical patient with SVT can be both diagnosed and cured during the same electrophysiology study (EPS). Complications are few, with the majority of patients discharged in less than 48 hours. Nursing care centers on pre- and postprocedural teaching, assessing the effects of radiofrequency energy and implementing nursing orders to prevent postablation complications.

Adult↗
PubMed1992

A comparison of two techniques of care for indwelling arterial introducers after coronary angioplasty.

To determine whether indwelling arterial introducers can be maintained for 24 hours without risk of infection and/or hemorrhage in the post-coronary angioplasty patient, 96 patients were assigned to one of two groups. Introducers of the subjects in group I were flushed with 500 U of heparin, capped, and covered with a sterile occlusive dressing. Introducers of subjects in group II were connected to a heparinized (500 U in 500 mL normal saline) and pressurized (200 to 300 mm Hg) flush device. All introducers were removed 24 hours after coronary angioplasty. Results of t tests showed no significant difference between the two groups in incidence of infection or hemorrhage when hemoglobin, hematocrit, partial thromboplastin time, and white blood cell count were compared. Signs of inflammation at the introducer site (redness and swelling) and temperature elevation > or = 37.8 degrees C were not significantly different between the two groups. The incidence of hematoma formation at the introducer site was 40% in both groups. The two methods were found to be equally effective in maintaining a patent arterial introducer without risking infection and/or hemorrhage in the post-coronary angioplasty patient whose introducer remains indwelling for 24 hours.

Academic Medical Centers↗